Association of CD44-/CD24- Breast Cancer Cells with Late Stage Tumor Recurrence

Tumor metastasis remains the main cause of breast cancer-related deaths, especially the later breast cancer distant metastasis. This study assessed CD44-/CD24- tumor cells in 576 tissue specimens for associations with clinicopathological features and metastasis and then investigated the underlying molecular events. The data showed that level of CD44-/CD24- cells was associated with later postoperative distant tumor metastasis. Furthermore, CD44-/CD24- triple negative cells could spontaneously convert into CD44+/CD24- cancer stem cells (CSCs) with properties similar to CD44+/CD24- CSCs from parental MDA-MB-231 cells in terms of gene expression, tumor cell xenograft formation, and lung metastasis in vitro and in vivo. Single-cell RNA sequencing identified RHBDL2 as a regulator that enhanced spontaneous CD44+/CD24- CSC conversion, whereas knockdown of RHBDL2 expression inhibited YAP/NF-{kappa}B signaling and blocked spontaneous CD44-/CD24- cell conversion to CSCs. These data suggested that the level of CD44-/CD24- tumor cells could predict breast cancer prognosis, metastasis, and response to adjuvant therapy.